How Do Hospitals Prepare for a Pandemic?
Q&A with David Hutton
Associate Professor of Health Management and Policy
April 6, 2020, Faculty, Health Management and Policy, Coronavirus, Epidemic, Hospital Administration, Infectious Disease
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By now, you’ve probably heard a lot about hospitals and health systems not having enough supplies for staff to handle the significant increase in patients expected from the coronavirus pandemic.
But even when we’re not facing a global pandemic, influxes in patients happen fairly regularly, and there’s a lot hospitals have already been doing to prepare. What makes this situation different, and how are hospitals responding? And what does all this mean for you if you or your loved ones end up needing treatment for coronavirus?
To better understand all of this, we spoke with David Hutton, associate professor of Health Management and Policy at the University of Michigan School of Public Health and an expert in mathematical modeling of diseases and pandemic planning.
How do hospitals prepare for patient surges, and how is this playing out in the coronavirus pandemic?
In general, hospitals prepare for a lot of different events and make sure they have surge capacity in many different areas, such as equipment, space, and staff. Often, these involve relying on coordinating with other hospitals to increase capacity.
One of the challenges the coronavirus outbreak presents is that hospitals everywhere are asking for increased capacity at the same time. If hospital A was expecting to have hospital B help them out in time of crisis and hospital B is facing the same coronavirus crisis, they're both in trouble. The same thing happens with other needs, like personal protective equipment, masks, and respirators. It can be more challenging when this is something that impacts everyone all at once.
Hospitals across the country are exploring creative ways of expanding their capacity to help patients during this time. For example, due to concern about the number of respirators available, some hospitals are considering using them for longer periods of time. I’ve also heard reports out of University of Nebraska Medical Center where they're using ultraviolet light to decontaminate and reuse respirators that traditionally would be thought of as one-time use devices.
How is this impacting other normal operations at hospitals, such as elective procedures, childbirth, and even emergency care?
A lot of elective procedures are being postponed to expand capacity to handle other things. But even for non-elective procedures, you can imagine that if ICUs get filled with coronavirus patients, that means you can see fewer patients who might be having another emergency like heart attack or a stroke.
That can take away capacity from other patients who might need it for other normal, non-pandemic-related health care needs. Another thing that can be a problem is if staff are getting sick—we're seeing this around the world in China and Italy and other places—which also reduces the health care system’s capacity to care for patients.
With all these measures in place, if I do contract coronavirus and need care in a hospital setting, what can I expect?
The good news is, about 80 percent of people with coronavirus infections have mild or no symptoms. That's why you need to be really careful, so that if you do have an asymptomatic infection—if you have the virus but don’t have any symptoms—you're not an incubator growing the virus and spreading it to other people.
Some people are going to have symptoms, but the majority of the people who have symptoms do not need to be hospitalized. However, when we compare this to something like the regular seasonal flu, a much larger fraction of the population does end up needing hospitalization and potentially ICU care.
That's where things become more complicated. What happens if you need to be hospitalized depends on what everyone else does. If we're doing the right things with social distancing, we can flatten that curve and hopefully reduce the need for ICU care to a point that it is manageable for the health care system. If you are ill and you need to be hospitalized, you can go to the hospital. If the hospitals aren’t overburdened, you can get very good care. You’ll likely be seen by emergency physicians, you might spend some time in the hospital if needed, be sent to the ICU, and be treated with intubation and ventilation. Many people spend up to two weeks in the hospital recovering from coronavirus, but it varies from person to person.
If we don't do a good job of social distancing and hospitals are overwhelmed with patients, that's when things become more complicated. If the health care system is overburdened, you might be sent to an alternate hospital or to a makeshift temporary hospital in another building. Unfortunately, as we're seeing in places like Italy, there are some locations where ICUs are overburdened and medical staff have to make very difficult decisions about who gets on ventilators and who does not. We’re trying to avoid that through prevention strategies like social distancing.
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